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Ruptured Solitary Splenic Metastasis of Gastric Cancer after Gastric Cancer Operation.

Bo Sung SOHN ; Kee Hwan KIM ; Hak Jun SEO ; Ji Il KIM ; Chang Hyeok AHN ; Jeong Soo KIM ; Young Mi KU ; Ok Ran SHIN ; Keun Woo LIM

Journal of the Korean Surgical Society.2004;67(1):87-91.

Solitary malignant splenic metastasis is uncommon and usually occurs in association with widely disseminated metastatic disease. Splenic metastasis usually occurs late in the disease course, with widespread involvement of other organs and rarely shows any presenting symptoms. Virtually all primary tumors have been known to metastasize to the spleen. The common ones include melanoma, lung, breast and ovary cancer, but metastasis from gastric cancer is very rare. When solitary spleen metastasis is suspected in a clinical setting, aggressive treatment is indicated such as splenectomy followed by combined modality treatment to prevent dissemination of the disease. We experienced a case of solitary spleen metastasis and rupture after gastric cancer operation and reviewed the associated literatures.
Breast ; Lung ; Melanoma ; Neoplasm Metastasis* ; Ovarian Neoplasms ; Rupture ; Spleen ; Splenectomy ; Stomach Neoplasms*

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Retrograde Jejunojejunal Intussusception after Total Gastrectomy.

Byoung Yoon RYU ; Hae Sung KIM ; Tae Hwa KIM ; Jeong hoon LEE ; Han joon KIM ; Jang Yeong JEON ; Hong Ki KIM ; Jin Bong KIM ; Young Hee CHOI

Journal of the Korean Surgical Society.2004;67(1):82-86.

Retrograde jejunojejunal intussusception is an unusual complication of gastric surgery. Mortality rates are quite high, especially if corrective surgery is delayed for more than 48 hours. The common symptoms of retrograde jejunojejunal intussusception are epigastric pain, nausea, vomiting or hematemesis, and palpable mass. UGI series, abdominal sonography, abdominal CT, and endoscopy can be used to diagnose of retrograde jejunojejunal intussusception. We experienced two cases of retrograde jejunojejunal intussusception. One was a sixty-one-year-old male who was admitted because of epigastric pain, nausea and hematemesis. He had previously undergone total gastrectomy with Braun anastomosis due to gastric cancer seven years before. Abdominal CT and endoscopy were performed for diagnosis of intussusception of the upper jejunum. The other case was fifty-nine-year-old male who was admitted because of abdominal pain and vomiting. He also had previously undergone total gastrectomy with Braun anastomosis due to gastric cancer seven years before. On physical examination, the abdomen was flat and the mass was palpated in periumbilical area. UGI series, abdominal CT, and abdominal sonography were performed. Both cases underwent operation by segmental resection of the intussusceptum and the patients discharged without complication. We experienced two cases of unusual retrograde jejunojejunal intussusception and report with a review of the literature.
Abdomen ; Abdominal Pain ; Diagnosis ; Endoscopy ; Gastrectomy* ; Hematemesis ; Humans ; Intussusception* ; Jejunum ; Male ; Mortality ; Nausea ; Physical Examination ; Stomach Neoplasms ; Tomography, X-Ray Computed ; Vomiting

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Intestinal Obstruction Due to Incarcerated Hernia at CAPD Catheter Insertion Site.

Gyu Ha JUN ; Nak Hee KIM ; Hyun Kyu LEE ; Jung Min BAE ; Jong Dae BAE ; Eun A CHOI ; Ho Geun JUNG ; Tae Jung JANG ; Ki Hoon JUNG ; Byung Wook JUNG

Journal of the Korean Surgical Society.2004;67(1):79-81.

Patients who have undergone peritoneal dialysis can frequently experience abdominal wall complications, such as hernia due to increased intraabdominal pressure and peritoneal leakage. However, no case of incarcerated abdominal wall hernia through catheter insertion site of CAPD has yet been reported Recently the authors experienced a case of intestinal obstruction due to an incarcerated hernia at the catheter insertion site of CAPD. We report this case and present a literature review.
Abdominal Wall ; Catheters* ; Hernia* ; Humans ; Intestinal Obstruction* ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory*

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Localized Peritonitis due to Perforation of Multiple Jejunal Diverticula.

Bong Gyu LEE ; Sung Bae PARK ; Chang Gyoo BYUN ; Young Taeg KOH ; Dong Youb SUH ; Dong Sun PARK ; Moon Ja KANG ; Kwun Jun LEE

Journal of the Korean Surgical Society.2004;67(1):75-78.

We report the case of a 77-year-old woman who presented with periumbilical pain from perforation of jejunal diverticula. The patient underwent surgery and multiple jejunal diverticula were found distributed from 30 cm to 60 cm distal to the ligament of Treitz. A segment of the jejunum containing all diverticula was resected and end-to-end anastomosis was performed. The postoperative course was uneventful. The patient continued to do well at last follow-up, 26 months after operation. Diverticulum of the jejunum is uncommon and the majority of patients are asymptomatic. Symptoms indicating diverticulum are few and often nonspecific; they may present either as generalized abdominal pain associated with intestinal disturbances or in more serious case, they can lead to complications requiring emergency surgery. In light of these considerations, we thought it useful to report a case of complicated multiple jejunal diverticula and draw attention to its complications that can be a source of gastrointestinal symptoms.
Abdominal Pain ; Aged ; Diverticulum* ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Jejunum ; Ligaments ; Peritonitis*

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Necrotizing Fasciitis Secondary to Perforated Appendicitis.

Kyoung Hoon KO ; Yong Pil CHO ; Seung Mun JUNG ; Soo jung CHOI ; Seong Su KIM ; Hyuk Jai JANG ; Yong Ho KIM ; Myoung Sik HAN

Journal of the Korean Surgical Society.2004;67(1):70-74.

Necrotizing fasciitis is a rapidly progressing soft-tissue infection that affects the subcutaneous fascia and dermis, and characteristically spares the underlying muscle. Most cases represent a synergistic or mixed bacterial infection of aerobes and anaerobes. A variety of etiologies have been reported. Herein, two cases of necrotizing fasciitis of the right thigh secondary to perforated appendicitis, an extremely rare complication, are reported. Both cases recovered following aggressive surgical and medical therapies. The delay in diagnosis and radical surgical excision are frequent and significant contributory factors in the high reported mortality rate. A high index of suspicion, followed by prompt surgical intervention with broad-spectrum antibiotic therapy, seems to be the most important prognostic factor in these difficult cases.
Appendicitis* ; Bacterial Infections ; Dermis ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Mortality ; Thigh

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The Comparative Analysis between Laparoscopic and Open Appendectomy.

See Youn LEE ; Yong Gum PARK ; In Taik CHANG

Journal of the Korean Surgical Society.2004;67(1):65-69.

PURPOSE: Nowadays laparoscopic appendectomy is widely practiced in developed countries. The purpose of this study was to evaluate laparoscopic appendectomy in comparison with open appendectomy. METHODS: On hundred cases each of laparoscopic appendectomy and open appendectomy, performed between February 2001 and June 2002, were reviewed for age, sex, operative time, hospital days, time for first meal, number of used parenteral analgesia, number of OPD visits, etc. RESULTS: Operative time was longer in the laparoscopic appendectomy group (P>0.05) and the number of used parenteral analgesia was slightly higher in the laparoscopic group (P>0.05). However, recovery time for diet was slightly shorter in the laparoscopic group (P>0.05). None of these trends were statistically significant. The times of OPD visit after discharge was less in the laparoscopic group (P<0.05). The hospital days of pathological simple appendicitis were shorter in the laparoscopic appendectomy group (P<0.05). In the laparoscopic group, intraabdominal abscess was developed in 2 cases, wound infection in 4, and intestinal obstruction in 2. The conversion rate to open appendectomy was 7% (7/100) in the laparoscopic group. CONCLUSION: Laparoscopic appendectomy can shorten overall OPD follow up days and in case of simple appendicitis, laparoscopic appendectomy can also shorten hospital days.
Abscess ; Analgesia ; Appendectomy* ; Appendicitis ; Developed Countries ; Diet ; Follow-Up Studies ; Intestinal Obstruction ; Meals ; Operative Time ; Wound Infection

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A Study of Sixty Consecutive Whipple Procedure by Single Surgeon.

Jun Ho SHIN ; Won Kon HAN

Journal of the Korean Surgical Society.2004;67(1):60-64.

PURPOSE: To review the current standards of pancreaticoduodectomies and show that excellent results can be achieved by a single surgeon. METHODS: A case series of consecutive patients, operated on during the period March 1999 to February 2003, were retrospectively evaluated. The patients' medical records were abstracted for demographic data, clinical presentation, operative indication, operative time, amount of transfusion, perioperative morbidity, mortality and other operative records. RESULTS: The average age was 57.5 years, ranging from 35 to 78. Jaundice was the main presenting symptom (68.3%) and preoperative PTBD was performed at 34 cases (56.7%). The most common indication for this procedure was cancer of the ampulla of Vater (28 cases, 47.3%) and the second was pancreatic head cancer (14 cases, 23.6%). A total of 60 patients underwent a pancreaticoduodectomy during the 4 year period. Fifty-three patients underwent a pylorus- preserving pancreaticoduodectomy (PPPD) and 5 a classical Whipple procedure. The operation lasted an average of 367 minutes, ranging from 250 to 555. The mean operative blood loss was 750 ml, ranging from 180 to 2400. About seventy- two percent of patients had no major complications, 28% had one or two more major complications and there was only one operative mortality (1.7%). The major morbidity was leakage of the pancreaticojejunostomy (5 cases, 8.3%). Delayed gastric emptying occurred in 6 patients. CONCLUSION: The above study demonstrates that a complicated procedure, such as the Whipple pancreaticoduodectomy, can be performed with excellent results by a single surgeon with sufficient experience. The most important prerequisite is that the surgeon be adequately trained in the procedure. In low-volume hospitals, the case load should be restricted to a minimal number of trained surgeons in order to concentrate the experience.
Ampulla of Vater ; Gastric Emptying ; Head and Neck Neoplasms ; Hospitals, Low-Volume ; Humans ; Jaundice ; Medical Records ; Mortality ; Operative Time ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Retrospective Studies

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Correlation of the Serum Nitrate/Nitrite Level with the Severity of Biliary Tract Inflammation.

Kyong Ho CHOI ; Hae Seung KIM ; Yun Seung CHOI ; Eung Ho CHO ; Seung Ik AHN ; Keon Young LEE ; Kee Chun HONG ; Sun Keun CHOI ; Yoon Seok HUR ; Sei Joong KIM ; Ze Hong WOO ; Seok Hwan SHIN ; Suk Ho CHA ; Young Nam CHA

Journal of the Korean Surgical Society.2004;67(1):55-59.

PURPOSE: The relationship between the biophysical and biochemical processes of gallbladder bile and nitric oxide is still not well known. In this study, the correlation between nitric oxide production and the degree of biliary tract inflammation was investigated and the levels of nitrate/nitrite (NOx) and stable metabolite of nitric oxide in the serum proposed for assessing the severity of biliary tract inflammation. METHODS: Eighty two patients with biliary tract inflammation who underwent operative treatment between March and July 2002 were included in this study. Of the 82 patients, there were 31 and 51 men and women, respectively. The mean age was 53, ranging from 21 to 82 years. The subjects were divided into three groups, GB stone (n=42), and acute cholecystitis (n=27), and cholangitis (n= 13). The severity of biliary tract inflammation was assessed using the WBC count, total bilirubin count, GB wall thickness on pathology, bile duct stone detected on ultrasonography, open conversion of cholecystectomy, pyrexia and tenderness/rebound tenderness on physical examination. The serum NOx concentrations were analyzed according to the groups, clinicopathological, laboratory and radiological findings. The serum NOx levels were measured using the Griess reaction after conversion of all nitrates to nitrites. RESULTS: The nitrate/nitrite levels in the GB, acute cholecystitis and cholangitis groups were 70.0+/-44.6, 126.8+/-54.5 and 142.0+/-44.6mumol/L, respectively, with statistical differences between the three groups (P< 0.05). The NOx level in patients with pyrexia, hyperbilirubinemia, leukocytosis, GB wall thickness on pathology and open conversion were markedly increased compared with the control group (P<0.05). These data demonstrate the relationship between the intensity of nitric oxide and the severity of biliary tract inflammation. CONCLUSION: Measurement of the NOx concentration in patients with biliary tract inflammation provides information about the severity and course of the disease. These results suggest there is a correlation between nitric oxide and the degree of biliary tract inflammation.
Bile ; Bile Ducts ; Biliary Tract* ; Bilirubin ; Biochemical Processes ; Cholangitis ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Female ; Fever ; Gallbladder ; Humans ; Hyperbilirubinemia ; Inflammation* ; Leukocytosis ; Male ; Nitrates ; Nitric Oxide ; Nitrites ; Pathology ; Physical Examination ; Ultrasonography

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Roles of cFLIPL in Fas-mediated Apoptosis of Colon Cancer.

Yong Ho KIM ; Choong YOON ; Jae Hoon PARK

Journal of the Korean Surgical Society.2004;67(1):47-54.

PURPOSE: Substantial numbers of the colon cancer cells have been observed to express Fas/Fas ligands, but are resistant to Fas-mediated apoptosis, suggesting that colon tumors might develop the specific mechanisms to overcome Fas-mediated apoptosis. Recently, cellular FLICE-like inhibitory protein (cFLIP) has been identified as an endogenous inhibitor of Fas- or other receptor-mediated apoptosis and its altered high expression has been suspected to be associated with tumor development or progression. This study investigated the prevalence of cFLIPL alterations in colon carcinomas and possible implications in the progression of colon cancers. METHODS: In order to investigate the function of cFLIPL for the development and progression of the colon cancer, we analyzed the expression of the cFLIPL in 58 colon cancer and 6 colon cancer cell lines. RESULTS: The study results demonstrated that cFLIPL is one of the major determinants for sensitivity to Fas-mediated apoptosis in colon cancer cell lines. In addition, we analyzed cFLIPL expression in 58 cases of adenocarcinoma of the colon and showed that cFLIPL, expression was increased in adenocarcinoma as compared to matched normal mucosa. CONCLUSION: Taken together, our data strongly suggested that abnormal overexpression of cFLIPL is a frequent event in colon carcinomas and might contribute to in vivo tumor transformation.
Adenocarcinoma ; Apoptosis* ; Cell Line ; Colon* ; Colonic Neoplasms* ; Ligands ; Mucous Membrane ; Prevalence

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Effectiveness and Side Effects of Postoperative Pain Control Methods in Stomach and Colorectal Cancer Patients.

Ji Hoon KIM ; Sung Joon KWON ; Heung Woo LEE ; Hee Koo YOO

Journal of the Korean Surgical Society.2004;67(1):41-46.

PURPOSE: The goal of postoperative pain management is to provide safe, continuous, effective analgesia, free from unwanted side effects. In doing so, it is hoped that postoperative morbidity is reduced, facilitating recovery, and hasten discharge from hospital. However, the effects of patient-controlled analgesia (PCA) and complications after a major gastrointestinal operation are currently unclear. METHODS: Fifty four and 31 patients who had undergone an elective gastrectomy due to stomach cancer and elective colorectal surgery due to colorectal cancer, respectively, between August 2002 and April 2003 at the Hanyang University Hospital, were allocated to one of two groups; One received patient-controlled analgesia (PCA group), the other received preoperative fentanyl patch appliment (Patch group). The kind and amount of additional analgesics demanded, pain scale, clinical course, and side effects were analyzed. RESULT: After the stomach cancer surgery, the average postoperative pain scores (numeric scale+pain face scale) in the PCA and patch groups were 9.44 and 10.76, respectively (P=0.0325). After the colorectal cancer surgery, the average postoperative pain scores in the PCA and patch groups were 6.44 and 9.22, respectively (P=0.0072). The amount of additional analgesic agent required after gastrointestinal surgery was variable and unpredictable, but IV PCA resolved this problems and markedly reduced the need for additional analgesic agents. The clinical courses of the PCA and patch groups did not differ in terms of gas passing and resumption of diet. The complication rates of the two groups were similar. CONCLUSION: IV PCA after gastrointestinal surgery for stomach and colon cancers is better for the management of postoperative pain than other pain control methods, with similar complication rates.
Analgesia ; Analgesia, Patient-Controlled ; Analgesics ; Colonic Neoplasms ; Colorectal Neoplasms* ; Colorectal Surgery ; Diet ; Fentanyl ; Gastrectomy ; Hope ; Humans ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Stomach Neoplasms ; Stomach*

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